Oropharyngeal colostrum administration in neonates with gastroschisis: a randomized clinical trial.

OBJECTIVE: To evaluate the effect of colostrum therapy on days to start a suckling diet in newborns diagnosed with simple gastroschisis. METHODS: Randomized clinical trial with newborns diagnosed with simple gastroschisis at a federal hospital in Rio de Janeiro who were randomized to receive oropharyngeal administration of 0.2mL of colostrum or a "sham procedure" during the first 3 days of life. The analysis included clinical outcomes such as days without food, days with parenteral feeding, days until the start of enteral feeding, days to reach complete enteral feeding, sepsis and length of hospital stay. RESULTS: The onset of oral feeding (suction) in patients with simple gastroschisis in both groups occurred at a median of 15 days. CONCLUSION: The present study showed that there were no significant differences in the use of colostrum therapy and the number of days to the start of enteral feeding and suction diet between groups of newborns with simple gastroschisis.

Use of prophylactic phototherapy for RhD neonatal disease in a referral service

Abstract Objective: This study aimed to describe the effect of prophylactic phototherapy in the treatment of infants with Neonatal Hemolytic Disease. Method: A retrospective cohort study was carried out with 199 RhD-positive infants, born to RhD-negative mothers, alloimmunized for RhD antigen, between January 2009 and December 2018. Results: The incidence of exchange transfusions in the study population was 9.5%, with a mean maximum bilirubin value of 11.3 mg % (± 4.3mg %). Bilirubin's maximum peak was achieved with a mean of 119.2 life hours (± 70.6h). Conclusions: The low incidence of exchange transfusion, the extended maximum bilirubin peak for later ages, and the low mean of the maximum bilirubin values may indicate a positive effect of prophylactic phototherapy in the treatment of this disease. Further studies must be carried out to confirm these findings.

Use of prophylactic phototherapy for RhD neonatal disease in a referral service.

OBJECTIVE: This study aimed to describe the effect of prophylactic phototherapy in the treatment of infants with Neonatal Hemolytic Disease. METHOD: A retrospective cohort study was carried out with 199 RhD-positive infants, born to RhD-negative mothers, alloimmunized for RhD antigen, between January 2009 and December 2018. RESULTS: The incidence of exchange transfusions in the study population was 9.5%, with a mean maximum bilirubin value of 11.3 mg % (± 4.3mg %). Bilirubin's maximum peak was achieved with a mean of 119.2 life hours (± 70.6h). CONCLUSION: The low incidence of exchange transfusion, the extended maximum bilirubin peak for later ages, and the low mean of the maximum bilirubin values may indicate a positive effect of prophylactic phototherapy in the treatment of this disease. Further studies must be carried out to confirm these findings.

Influence of different breast expression techniques on human colostrum macronutrient concentrations.

OBJECTIVE: To evaluate the effects of breast expression methods on macronutrient and caloric concentrations in human colostrum. STUDY DESIGN: A cross-sectional study in which colostrum samples were collected simultaneously from each breast using different milk expression methods, including manual expression or electric pumping, assigned by simple randomization. Macronutrients were measured by infrared spectroscopy, and their concentrations were compared by the Wilcoxon test. RESULTS: Ninety-six samples from each breast of selected donors were evaluated. There were no differences in carbohydrate (6.1 vs. 6.1 g/dL; p: 0.218) and protein (2.1 vs. 2.1 g/dL; p: 0.772) concentrations between the samples collected by manual expression and electric pumping. However, in those collected by manual expression, lipid concentrations (2.6 vs. 2.2 g/dL; p < 0.001) and caloric content (60 vs. 57 Kcal/dL; p = 0.001) were higher. CONCLUSIONS: Colostrum collected by hand expression had a higher lipid concentration and caloric content than that collected by an electric pump.

[The need to act together in every way possible: inter-sector action in health and education for children living with the congenital Zika syndrome]. / De toda maneira tem que andar junto: ações intersetoriais entre saúde e educação para crianças vivendo com a síndrome congênita do vírus Zika.

The experience with an intervention program conducted in an educational institution and targeted to families of children with congenital Zika syndrome, which includes multiple disabilities, revealed the challenges and strides with the entry of these families in the school system. This article aimed to explore the findings from a study conducted after the conclusion of an intervention program, using semi-open interviews with professional staff at the institution and the possible contributions towards establishing inter-sector relations aimed at school inclusion of children with disabilities. A change was seen, as a result of the program, in the relationship between the families and the professionals at the educational institution, whereby the families had room to voice their fears and discuss the school's role in the lives of their children with disabilities. The professionals thus came to see the families taking a more active stance. This experience can favor other services and municipalities that seek school inclusion for children and adolescents with disabilities, as well as their social inclusion and that of their families.

Com base na experiência de um programa de intervenção para famílias de crianças com a síndrome congênita do vírus Zika, que inclui múltiplas deficiências, em uma instituição de educação, foram observados os desafios e conquistas encontrados com a entrada dessas famílias no sistema escolar. O objetivo deste artigo foi explorar os achados de pesquisa realizada após a conclusão de um programa de intervenção mediante entrevistas semiabertas com profissionais da instituição, e as possíveis contribuições para a construção das relações intersetoriais visando à inclusão escolar de crianças com deficiência. É possível constatar uma mudança provocada pelo programa na relação entre as famílias e os profissionais da instituição de educação; as famílias tiveram espaço para elaborar seus receios e discutir o papel da escola na vida de crianças com deficiência. Dessa forma, os profissionais passaram a vê-las em uma posição mais ativa. Acredita-se que esta experiência possa favorecer outros serviços e municípios que busquem a inclusão escolar de crianças e adolescentes com deficiência assim como sua inclusão social e de suas famílias.

A partir de la experiencia de un programa de intervención para familias de niños con el síndrome congénito del virus Zika, que incluye múltiples discapacidades, en una institución educativa se observaron los desafíos y logros que se consiguieron tras la entrada de esas familias en el sistema escolar. El objetivo de este artículo fue analizar los resultados de la investigación realizada, tras la conclusión de un programa de intervención, a través de entrevistas semiabiertas con profesionales de la institución, así como las posibles contribuciones en la construcción de relaciones intersectoriales, con el fin de la inclusión escolar de niños con discapacidad. Es posible observar el cambio provocado por el programa en la relación entre las familias y los profesionales de la institución educativa, debido a que las familias contaron con un espacio para exponer sus recelos y discutir el papel de la escuela en la vida de niños con discapacidad. De esta forma, los profesionales pasaron a ser vistos desde una posición más activa. Se cree que esta experiencia puede favorecer a otros servicios y municipios que busquen la inclusión escolar de niños y adolescentes con discapacidad, así como su inclusión social y la de sus familias.

Do maternal morbidities change the nutritional composition of human milk? A systematic review. / Morbidades maternas modificam a composição nutricional do leite humano? uma revisão sistemática.

This paper aims to identify the effects of maternal morbidities on the nutritional composition of human milk. This systematic review of the literature employed a PRISMA's protocol for searching, selecting, and extracting data. The flowchart proposed for bibliographic search resulted in 1,582 papers, of which 14 were selected for this work. The papers selected for this review were published between 1987 and 2016. Nine studies found significant differences in the nutritional composition of the milk of mothers with diabetes mellitus, arterial hypertension, or overweight compared to the control group. Most studies have shown that the presence of chronic diseases leads to changes in the nutritional composition of human milk. The main results showed a lower concentration of lactose and fat in the milk of women with diabetes mellitus. Concerning hypertension, higher levels of total protein were found in colostrum and mature milk. A higher fat and energy content was observed in overweight mothers. It is imperative that these women have continuous nutritional monitoring to minimize the impact of these morbidities on the nutritional composition of breast milk.

O objetivo deste artigo é identificar os efeitos das morbidades maternas sobre a composição nutricional do leite humano. Revisão sistemática da literatura utilizando protocolo PRISMA para a busca, seleção e extração de dados. De acordo com o fluxograma proposto a busca bibliográfica resultou em 1.582 artigos e, destes, 14 foram selecionados. Os artigos elegidos para a presente revisão foram publicados entre 1987 e 2016. Nove estudos verificaram diferenças significativas na composição nutricional do leite de mães com diabetes mellitus, hipertensão arterial ou excesso de peso em comparação ao grupo controle. A maioria dos estudos demonstrou que a presença de doenças crônicas acarreta modificações na composição nutricional do leite humano. Os principais resultados evidenciaram menor concentração de lactose e gordura no leite de mulheres com diabetes mellitus. Quanto a hipertensão, foi verificado níveis mais elevados de proteína total no colostro e no leite maduro. Para o excesso de peso, foi observado maior teor de gordura e energia. É de extrema importância que essas mulheres tenham acompanhamento nutricional contínuo a fim de minimizar o impacto dessas morbidades sobre a composição nutricional do leite humano.

Morbidades maternas modificam a composição nutricional do leite humano? uma revisão sistemática / Do maternal morbidities change the nutritional composition of human milk? A systematic review

Resumo O objetivo deste artigo é identificar os efeitos das morbidades maternas sobre a composição nutricional do leite humano. Revisão sistemática da literatura utilizando protocolo PRISMA para a busca, seleção e extração de dados. De acordo com o fluxograma proposto a busca bibliográfica resultou em 1.582 artigos e, destes, 14 foram selecionados. Os artigos elegidos para a presente revisão foram publicados entre 1987 e 2016. Nove estudos verificaram diferenças significativas na composição nutricional do leite de mães com diabetes mellitus, hipertensão arterial ou excesso de peso em comparação ao grupo controle. A maioria dos estudos demonstrou que a presença de doenças crônicas acarreta modificações na composição nutricional do leite humano. Os principais resultados evidenciaram menor concentração de lactose e gordura no leite de mulheres com diabetes mellitus. Quanto a hipertensão, foi verificado níveis mais elevados de proteína total no colostro e no leite maduro. Para o excesso de peso, foi observado maior teor de gordura e energia. É de extrema importância que essas mulheres tenham acompanhamento nutricional contínuo a fim de minimizar o impacto dessas morbidades sobre a composição nutricional do leite humano.

Abstract This paper aims to identify the effects of maternal morbidities on the nutritional composition of human milk. This systematic review of the literature employed a PRISMA's protocol for searching, selecting, and extracting data. The flowchart proposed for bibliographic search resulted in 1,582 papers, of which 14 were selected for this work. The papers selected for this review were published between 1987 and 2016. Nine studies found significant differences in the nutritional composition of the milk of mothers with diabetes mellitus, arterial hypertension, or overweight compared to the control group. Most studies have shown that the presence of chronic diseases leads to changes in the nutritional composition of human milk. The main results showed a lower concentration of lactose and fat in the milk of women with diabetes mellitus. Concerning hypertension, higher levels of total protein were found in colostrum and mature milk. A higher fat and energy content was observed in overweight mothers. It is imperative that these women have continuous nutritional monitoring to minimize the impact of these morbidities on the nutritional composition of breast milk.

Infants with microcephaly due to ZIKA virus exposure: nutritional status and food practices.

BACKGROUND: Children with microcephaly due to vertical exposure to Zika virus are an interesting population for investigation. Highlighted among their unique aspects are those related to nutrition due to its impact on child growth and development. Knowledge about the nutrition of microcephalic infants can help mothers and caregivers provide better care. Thus, this study aimed to describe the nutritional status and feeding practices of infants with microcephaly due to Zika virus exposure at birth and 12-23 months of age. METHODS: This is a descriptive study developed from a cohort of patients attending a public institution of reference. A total of 65 infants attended outpatient nutrition clinics. The food practices were described using the 24-h food recall and food consumption indicators. Anthropometric measurements and consultations were made using the Child Health Handbook to obtain information on the nutritional status (weight, height and head circumference) at the time of consultation and birth. RESULTS: There was a significant decrease in z-scores for weight, height and head circumference (HC) from birth to the time of the consultation. However, most infants did not show weight-for-height deficits. Additionally, HC was correlated with the anthropometric indices weight-for-age, height-for-age, body mass index-for-age and weight-for-height. CONCLUSION: Infants exhibited a worsening of their nutritional status between birth and the time of their consultation, notably when we evaluated the indices of height and head circumference for age. The main inadequacies regarding dietary practices were low food diversity, use of ultra-processed products and low lipid intake.

De toda maneira tem que andar junto: ações intersetoriais entre saúde e educação para crianças vivendo com a síndrome congênita do vírus Zika / The need to act together in every way possible: inter-sector action in health and education for children living with the congenital Zika syndrome / De todas formas deben ir juntas de la mano: acciones intersectoriales entre salud y educación para niños que viven con el síndrome congénito del virus Zika

Resumo: Com base na experiência de um programa de intervenção para famílias de crianças com a síndrome congênita do vírus Zika, que inclui múltiplas deficiências, em uma instituição de educação, foram observados os desafios e conquistas encontrados com a entrada dessas famílias no sistema escolar. O objetivo deste artigo foi explorar os achados de pesquisa realizada após a conclusão de um programa de intervenção mediante entrevistas semiabertas com profissionais da instituição, e as possíveis contribuições para a construção das relações intersetoriais visando à inclusão escolar de crianças com deficiência. É possível constatar uma mudança provocada pelo programa na relação entre as famílias e os profissionais da instituição de educação; as famílias tiveram espaço para elaborar seus receios e discutir o papel da escola na vida de crianças com deficiência. Dessa forma, os profissionais passaram a vê-las em uma posição mais ativa. Acredita-se que esta experiência possa favorecer outros serviços e municípios que busquem a inclusão escolar de crianças e adolescentes com deficiência assim como sua inclusão social e de suas famílias.

Abstract: The experience with an intervention program conducted in an educational institution and targeted to families of children with congenital Zika syndrome, which includes multiple disabilities, revealed the challenges and strides with the entry of these families in the school system. This article aimed to explore the findings from a study conducted after the conclusion of an intervention program, using semi-open interviews with professional staff at the institution and the possible contributions towards establishing inter-sector relations aimed at school inclusion of children with disabilities. A change was seen, as a result of the program, in the relationship between the families and the professionals at the educational institution, whereby the families had room to voice their fears and discuss the school's role in the lives of their children with disabilities. The professionals thus came to see the families taking a more active stance. This experience can favor other services and municipalities that seek school inclusion for children and adolescents with disabilities, as well as their social inclusion and that of their families.

Resumen: A partir de la experiencia de un programa de intervención para familias de niños con el síndrome congénito del virus Zika, que incluye múltiples discapacidades, en una institución educativa se observaron los desafíos y logros que se consiguieron tras la entrada de esas familias en el sistema escolar. El objetivo de este artículo fue analizar los resultados de la investigación realizada, tras la conclusión de un programa de intervención, a través de entrevistas semiabiertas con profesionales de la institución, así como las posibles contribuciones en la construcción de relaciones intersectoriales, con el fin de la inclusión escolar de niños con discapacidad. Es posible observar el cambio provocado por el programa en la relación entre las familias y los profesionales de la institución educativa, debido a que las familias contaron con un espacio para exponer sus recelos y discutir el papel de la escuela en la vida de niños con discapacidad. De esta forma, los profesionales pasaron a ser vistos desde una posición más activa. Se cree que esta experiencia puede favorecer a otros servicios y municipios que busquen la inclusión escolar de niños y adolescentes con discapacidad, así como su inclusión social y la de sus familias.

Energy expenditure, growth, and nutritional therapy in appropriate and small for gestational age preterm infants / Gasto energético, crescimento e terapia nutricional em recém-nascidos pré-termo adequados e pequenos para idade gestacional

Abstract Objective: To evaluate the resting energy expenditure, growth, and quantity of energy and macronutrients intake in a group of preterm newborns. Methods: The cohort study was performed with appropriate and small for gestational age preterm infants (birth weight lower than 1500 g or gestational age < 32 weeks). Resting energy expenditure was measured using indirect calorimetry on the 7th, 14th, 21st, and 28th days of life, and at discharge. Length, head circumference and body weight were assessed weekly. Nutritional therapy was calculated during the hospital stay and the information for each type of food was recorded in software that calculates the total amount of energy and macronutrients. Results: 61 preterm infants were followed; 43 appropriate and 18 small for gestational age infants. There was no statistical difference for resting energy expenditure between the groups, and it increased from the first to the fourth week of life (appropriate: 26.3% and small: 21.8%). Energy intake in the first two weeks of life was well below the energy requirement. Conclusion: Considering that the results demonstrate high energy expenditure during the first weeks of life, there is an evident need to provide the best quality of nutrition for each child in the first weeks of life so that preterm infants with or without intrauterine growth restriction can achieve their maximum potential for growth and development.

Resumo Objetivo: Avaliar o gasto energético de repouso, o crescimento e a quantidade ofertada de energia e macronutrientes em um grupo de recém-nascidos pré-termo. Método: Foi feito estudo de coorte com recém-nascidos pré-termo adequados e pequenos para a idade gestacional (peso de nascimento inferior a 1.500 gramas ou idade gestacional < 32 semanas). O gasto energético foi avaliado com a calorimetria indireta nos dias 7°, 14°, 21°, 28° dias de vida e alta hospitalar. Medidas do comprimento, perímetro cefálico e peso corporal foram avaliadas semanalmente. A terapia nutricional foi calculada durante a internação do recém-nascido e as informações de cada tipo de alimentação foram registradas em um software que calcula a quantidade total de energia e macronutrientes. Resultados: Foram acompanhados 61 recém-nascidos, sendo 43 adequados e 18 pequenos para idade gestacional. O gasto energético de repouso não apresentou diferença estatística entre os grupos e aumentou entre a primeira e quarta semana de vida (adequados: 26,3% e pequenos: 21,8%). O aporte energético nas duas primeiras semanas de vida mostrou-se bem abaixo do requerimento energético mensurado pela calorimetria. Conclusão: Considerando os resultados que demonstram um gasto energético alto ao longo das primeiras semanas de vida, fica evidente a necessidade de fornecer ao recém-nascido pré-termo um melhor aporte energético já nas primeiras semanas de vida, para que os neonatos com ou sem restrição intrauterina possam atingir o seu potencial máximo de crescimento e desenvolvimento.

Congenital Zika virus syndrome in infants: repercussions for the promotion of families' mental health. / Síndrome congênita do Zika vírus em lactentes: repercussões na promoção da saúde mental das famílias.

This article aims to discuss the impacts of the promotion of families' mental health following the diagnosis of Zika virus infection in the pregnant woman and/or congenital Zika virus syndrome (CZVS) in the infant. The study also aims to foster reflection on mother-infant bonding in this context. The study is relevant not only because there is still so much to learn about CZVS, with its enormous capacity for dispersion and many doubts as to the physical consequences and psychological impacts, but also due to the urgent need to provide families and/or caregivers with guidelines for care and alternatives for dealing with the illness. The study was conducted in an outpatient clinic specifically providing care to children with CZVS at the Unit for Infectious Diseases in Pediatrics in a tertiary hospital of the Brazilian Unified National Health System (SUS) in Rio de Janeiro, Brazil. The team is multidisciplinary, and each member conducts an assessment based on their specific field of knowledge. This qualitative study drew on participant observation, and the data analysis showed that the use of virtual social networks, which function (independently of the medicine approaches) as channels for communication and collective discussion of the different experiences, in order to share strategies to overcome the diagnosed impossibilities.

Este artigo tem como objetivo discutir os impactos na promoção da saúde mental nas famílias a partir do diagnóstico de infecção pelo vírus Zika na gestante e/ou a presença da síndrome congênita do Zika vírus (SCZV) na criança. Busca ainda favorecer uma reflexão a respeito da construção do vínculo mãe-bebê nesse cenário. A relevância do estudo se dá não somente pelo fato de a SCZV ser ainda pouco conhecida, com uma enorme capacidade de dispersão e com muitas dúvidas quanto às consequências físicas e ao impacto psíquico causado, como também pela urgência em ser dada às famílias e/ou cuidadores diretrizes de acolhimento e alternativas para lidar com a doença. O estudo foi desenvolvido em ambulatório específico para o cuidado de crianças com SCZV da Unidade de Doenças Infecciosas em Pediatria de um hospital terciário do Sistema Único de Saúde (SUS) no Rio de Janeiro, Brasil. A equipe é caracterizada como multiprofissional e cada um de seus integrantes faz uma avaliação com base no campo de saber específico. A pesquisa de cunho qualitativo foi realizada valendo-se da observação participante, e a análise dos dados revelou que a utilização das redes sociais virtuais, as quais independentemente dos caminhos seguidos pela medicina, funcionam como veículo de comunicação e discussão coletiva de diferentes vivências, no intuito de compartilhar estratégias para a superação de impossibilidades diagnosticadas.

El objetivo de este artículo es discutir impactos en la promoción de la salud mental dentro de las familias a cuyas gestantes se les ha diagnosticado infección por el virus Zika, y/o la presencia del síndrome congénito del virus Zika (SCZV, por sus siglas en portugués) en el niño. También pretende favorecer la reflexión respecto a la construcción del vínculo madre-bebé en este escenario. La relevancia del estudio se produce no solamente por el hecho de que el SCZV sea todavía poco conocido, con una enorme capacidad de dispersión, y con muchas dudas respecto a las consecuencias físicas y el impacto psíquico causado, sino también por la urgencia en proporcionar a las familias y/o cuidadores directrices de acogida y alternativas para enfrentarse a esta enfermedad. El estudio se desarrolló en un ambulatorio específico para el cuidado de niños con SCZV de la Unidad de Enfermedades Infecciosas en Pediatría de un hospital terciario del Sistema Único de Salud (SUS) en Río de Janeiro, Brasil. El equipo estaba caracterizado como multiprofesional y cada uno de sus integrantes realizó una evaluación a partir de un campo de saber específico. La investigación de cuño cualitativo se realizó a partir de la observación participante. El análisis de datos reveló que la utilización de las redes sociales virtuales, independientemente de los caminos seguidos por la medicina, funciona como un vehículo de comunicación y discusión colectiva sobre diferentes vivencias, con el fin de compartir estrategias para la superación de las imposibilidades diagnosticadas.

Energy expenditure, growth, and nutritional therapy in appropriate and small for gestational age preterm infants.

OBJECTIVE: To evaluate the resting energy expenditure, growth, and quantity of energy and macronutrients intake in a group of preterm newborns. METHODS: The cohort study was performed with appropriate and small for gestational age preterm infants (birth weight lower than 1500g or gestational age<32 weeks). Resting energy expenditure was measured using indirect calorimetry on the 7th, 14th, 21st, and 28th days of life, and at discharge. Length, head circumference and body weight were assessed weekly. Nutritional therapy was calculated during the hospital stay and the information for each type of food was recorded in software that calculates the total amount of energy and macronutrients. RESULTS: 61 preterm infants were followed; 43 appropriate and 18 small for gestational age infants. There was no statistical difference for resting energy expenditure between the groups, and it increased from the first to the fourth week of life (appropriate: 26.3% and small: 21.8%). Energy intake in the first two weeks of life was well below the energy requirement. CONCLUSION: Considering that the results demonstrate high energy expenditure during the first weeks of life, there is an evident need to provide the best quality of nutrition for each child in the first weeks of life so that preterm infants with or without intrauterine growth restriction can achieve their maximum potential for growth and development.

Síndrome congênita do Zika vírus em lactentes: repercussões na promoção da saúde mental das famílias / Síndrome congénito por el virus Zika en lactantes: repercusiones en la promoción de la salud mental de las familias / Congenital Zika virus syndrome in infants: repercussions for the promotion of families' mental health

Resumo: Este artigo tem como objetivo discutir os impactos na promoção da saúde mental nas famílias a partir do diagnóstico de infecção pelo vírus Zika na gestante e/ou a presença da síndrome congênita do Zika vírus (SCZV) na criança. Busca ainda favorecer uma reflexão a respeito da construção do vínculo mãe-bebê nesse cenário. A relevância do estudo se dá não somente pelo fato de a SCZV ser ainda pouco conhecida, com uma enorme capacidade de dispersão e com muitas dúvidas quanto às consequências físicas e ao impacto psíquico causado, como também pela urgência em ser dada às famílias e/ou cuidadores diretrizes de acolhimento e alternativas para lidar com a doença. O estudo foi desenvolvido em ambulatório específico para o cuidado de crianças com SCZV da Unidade de Doenças Infecciosas em Pediatria de um hospital terciário do Sistema Único de Saúde (SUS) no Rio de Janeiro, Brasil. A equipe é caracterizada como multiprofissional e cada um de seus integrantes faz uma avaliação com base no campo de saber específico. A pesquisa de cunho qualitativo foi realizada valendo-se da observação participante, e a análise dos dados revelou que a utilização das redes sociais virtuais, as quais independentemente dos caminhos seguidos pela medicina, funcionam como veículo de comunicação e discussão coletiva de diferentes vivências, no intuito de compartilhar estratégias para a superação de impossibilidades diagnosticadas.

Resumen: El objetivo de este artículo es discutir impactos en la promoción de la salud mental dentro de las familias a cuyas gestantes se les ha diagnosticado infección por el virus Zika, y/o la presencia del síndrome congénito del virus Zika (SCZV, por sus siglas en portugués) en el niño. También pretende favorecer la reflexión respecto a la construcción del vínculo madre-bebé en este escenario. La relevancia del estudio se produce no solamente por el hecho de que el SCZV sea todavía poco conocido, con una enorme capacidad de dispersión, y con muchas dudas respecto a las consecuencias físicas y el impacto psíquico causado, sino también por la urgencia en proporcionar a las familias y/o cuidadores directrices de acogida y alternativas para enfrentarse a esta enfermedad. El estudio se desarrolló en un ambulatorio específico para el cuidado de niños con SCZV de la Unidad de Enfermedades Infecciosas en Pediatría de un hospital terciario del Sistema Único de Salud (SUS) en Río de Janeiro, Brasil. El equipo estaba caracterizado como multiprofesional y cada uno de sus integrantes realizó una evaluación a partir de un campo de saber específico. La investigación de cuño cualitativo se realizó a partir de la observación participante. El análisis de datos reveló que la utilización de las redes sociales virtuales, independientemente de los caminos seguidos por la medicina, funciona como un vehículo de comunicación y discusión colectiva sobre diferentes vivencias, con el fin de compartir estrategias para la superación de las imposibilidades diagnosticadas.

Abstract: This article aims to discuss the impacts of the promotion of families' mental health following the diagnosis of Zika virus infection in the pregnant woman and/or congenital Zika virus syndrome (CZVS) in the infant. The study also aims to foster reflection on mother-infant bonding in this context. The study is relevant not only because there is still so much to learn about CZVS, with its enormous capacity for dispersion and many doubts as to the physical consequences and psychological impacts, but also due to the urgent need to provide families and/or caregivers with guidelines for care and alternatives for dealing with the illness. The study was conducted in an outpatient clinic specifically providing care to children with CZVS at the Unit for Infectious Diseases in Pediatrics in a tertiary hospital of the Brazilian Unified National Health System (SUS) in Rio de Janeiro, Brazil. The team is multidisciplinary, and each member conducts an assessment based on their specific field of knowledge. This qualitative study drew on participant observation, and the data analysis showed that the use of virtual social networks, which function (independently of the medicine approaches) as channels for communication and collective discussion of the different experiences, in order to share strategies to overcome the diagnosed impossibilities.

Are There Changes in the Fatty Acid Profile of Breast Milk with Supplementation of Omega-3 Sources? A Systematic Review.

Purpose To evaluate the effect of supplementation with omega-3 sources on the fatty acid composition of human milk. Methods The review consisted of the search for articles published in PubMed, Biblioteca Virtual de Saúde (Virtual Health Library[VHL]) and Web of Science databases using the following keywords: fatty acids, omega-3, human milk and supplementation; for this purpose, we have used the program of research to integrate the services for the maintenance of autonomy (PRISMA) checklist. The following selection criteria were used: articles in English, Portuguese, Spanish or Italian, published between 2000 and 2015, and about studies performed in humans. We found 710 articles that met the established criteria; however, only 22 of them were selected to be part of this study. Results All studies found a positive relationship between the consumption of omega-3 sources and their concentration in human milk. The differences in the findings are due to the distinct methods used, such as the specific time of the omega-3 supplementation, the type of omega-3 source offered, as well as the sample size. Conclusion Although the studies were different in several methodological aspects, it was possible to observe the importance of omega-3 supplementation during gestation and/or the puerperium.

Are There Changes in the Fatty Acid Profile of Breast Milk with Supplementation of Omega-3 Sources? A Systematic Review / Existem mudanças no perfil de ácidos graxos no leite materno com a suplementação de fontes de ômega 3? Uma revisão sistemática

Abstract Purpose To evaluate the effect of supplementation with omega-3 sources on the fatty acid composition of human milk. Methods The review consisted of the search for articles published in PubMed, Biblioteca Virtual de Saúde (Virtual Health Library[VHL]) andWeb of Science databases using the following keywords: fatty acids, omega-3, human milk and supplementation; for this purpose, we have used the program of research to integrate the services for the maintenance of autonomy (PRISMA) checklist. The following selection criteria were used: articles in English, Portuguese, Spanish or Italian, published between 2000 and 2015, and about studies performed in humans. We found 710 articles that met the established criteria; however, only 22 of them were selected to be part of this study. Results All studies found a positive relationship between the consumption of omega- 3 sources and their concentration in humanmilk. The differences in the findings are due to the distinct methods used, such as the specific time of the omega-3 supplementation, the type of omega-3 source offered, as well as the sample size. Conclusion Although the studies were different in several methodological aspects, it was possible to observe the importance of omega-3 supplementation during gestation and/or the puerperium.

Resumo Objetivo Avaliar o efeito da suplementação com fontes de ômega 3 sobre a composição de ácidos graxos do leite humano. Métodos A revisão consistiu na busca de artigos publicados nas bases de dados PubMed, Biblioteca Virtual de Saúde e Web of Science utilizando-se as palavras-chave: ácidos graxos, ômega-3, leitematerno e suplementação; para isso, foi utilizado o checklist PRISMA. Foram utilizados os seguintes critérios para a seleção: artigos publicados em inglês, português, espanhol ou italiano, entre os anos de 2000 a 2015, sobre estudos realizados em humanos. A busca bibliográfica, segundo a estratégia estabelecida, resultou em 710 artigos. Entretanto, apenas 22 destes foram selecionados para compor a presente revisão. Resultados Todos os estudos encontraram relação positiva entre o consumo de fontes de ômega 3 e sua concentração no leite humano. As diferenças nos achados se devem aos métodos empregados como, por exemplo, o momento da suplementação do ômega 3, o tipo de fonte de ômega 3 ofertado, e o tamanho amostral. Conclusão Apesar de os estudos serem díspares em inúmeros aspectos metodológicos, observou-se a importância da suplementação do ômega 3 na gestação e/ou no puerpério.

Micronutrient supplementation adherence and influence on the prevalences of anemia and iron, zinc and vitamin A deficiencies in preemies with a corrected age of six months.

OBJECTIVE: To analyze adherence to the recommended iron, zinc and multivitamin supplementation guidelines for preemies, the factors associated with this adherence, and the influence of adherence on the occurrence of anemia and iron, zinc and vitamin A deficiencies. METHODS: This prospective cohort study followed 58 preemies born in 2014 until they reached six months corrected age. The preemies were followed at a referral secondary health service and represented 63.7% of the preterm infants born that year. Outcomes of interest included high or low adherence to iron, zinc and multivitamin supplementation guidelines; prevalence of anemia; and prevalences of iron, zinc, and vitamin A deficiencies. The prevalence ratios were calculated by Poisson regression. RESULTS: Thirty-eight (65.5%) preemies presented high adherence to micronutrient supplementation guidelines. At six months of corrected age, no preemie had vitamin A deficiency. The prevalences of anemia, iron deficiency and zinc deficiency were higher in the low-adherence group but also concerning in the high-adherence group. Preemies with low adherence to micronutrient supplementation guidelines were 2.5 times more likely to develop anemia and 3.1 times more likely to develop zinc deficiency. Low maternal education level increased the likelihood of nonadherence to all three supplements by 2.2 times. CONCLUSIONS: Low maternal education level was independently associated with low adherence to iron, zinc and vitamin A supplementation guidelines in preemies, which impacted the prevalences of anemia and iron and zinc deficiencies at six months of corrected age.

Micronutrient supplementation adherence and influence on the prevalences of anemia and iron, zinc and vitamin A deficiencies in preemies with a corrected age of six months

OBJECTIVE: To analyze adherence to the recommended iron, zinc and multivitamin supplementation guidelines for preemies, the factors associated with this adherence, and the influence of adherence on the occurrence of anemia and iron, zinc and vitamin A deficiencies. METHODS: This prospective cohort study followed 58 preemies born in 2014 until they reached six months corrected age. The preemies were followed at a referral secondary health service and represented 63.7% of the preterm infants born that year. Outcomes of interest included high or low adherence to iron, zinc and multivitamin supplementation guidelines; prevalence of anemia; and prevalences of iron, zinc, and vitamin A deficiencies. The prevalence ratios were calculated by Poisson regression. RESULTS: Thirty-eight (65.5%) preemies presented high adherence to micronutrient supplementation guidelines. At six months of corrected age, no preemie had vitamin A deficiency. The prevalences of anemia, iron deficiency and zinc deficiency were higher in the low-adherence group but also concerning in the high-adherence group. Preemies with low adherence to micronutrient supplementation guidelines were 2.5 times more likely to develop anemia and 3.1 times more likely to develop zinc deficiency. Low maternal education level increased the likelihood of nonadherence to all three supplements by 2.2 times. CONCLUSIONS: Low maternal education level was independently associated with low adherence to iron, zinc and vitamin A supplementation guidelines in preemies, which impacted the prevalences of anemia and iron and zinc deficiencies at six months of corrected age.

High-intensity phototherapy for the treatment of severe nonhaemolytic neonatal hyperbilirubinemia.

AIM: To describe the clinical approach to term and near-term newborn infants with severe hyperbilirubinaemia and to analyse the effect of high-intensity phototherapy on total serum bilirubin (TSB) levels. METHODS: We analysed a cohort of 116 newborn infants with severe nonhaemolytic hyperbilirubinaemia (TSB ≥20 mg/dL/342 µmol/L). All patients were treated with high-intensity phototherapy. The main outcomes were reduction in TSB levels in the first 24 h of phototherapy, incidence of exchange transfusion, pathological brainstem auditory evoked responses and pathological findings on neurological examination at discharge. RESULTS: The mean birth weight and gestational age were 3161±466 g and 37.8±1.6 weeks. Mean initial TSB concentration was 22.4±2.4 mg/dL. Per cent decreases in TSB after 2, 4, 6, 12, 18 and 24 h of phototherapy were 9.4%, 16%, 23%, 40%, 44% and 50%, respectively. No infant was treated with exchange transfusion. Brainstem evoked response audiometry (BAER) was performed in 100% of the patients, and in three of them, this examination was altered. However, when repeated 3 months later, these BAER examinations were normal. Neurological examination was normal in all patients. CONCLUSIONS: High-intensity phototherapy significantly reduces TSB in nonhaemolytic severe hyperbilirubinaemia and decreases the need for exchange transfusion.

Mist and water condensation inside incubators reduce the efficacy of phototherapy.

OBJECTIVE: To measure the irradiance in humidified incubator under three different overhead phototherapy devices. DESIGN/METHODS: The effective irradiance of three phototherapy devices was assessed by taking a series of irradiance measurements in the illuminated field. Measurements were made with a fixed bandwidth broadband radiometer (380-530 nm). The distance between the light source and the radiometer was 35 cm for the daylight fluorescent lamp, 40 cm for the light emitting diode (LED) and 50 cm for the halogen phototherapy. A double-wall incubator was kept at 36°C and set at three different levels of humidity (60-70%, 80% and equal or above 90%). RESULTS: The irradiance under the overhead daylight fluorescent lamp phototherapy did not change with the increasing humidity. However, above 90% humidity, when water vapour inside the incubator was so saturated to the point of totally condensing in the incubator walls, the measured irradiance decreased 15% of the initial values with the blue LED phototherapy and 45% with the halogen spotlight phototherapy. CONCLUSIONS: Highly humidified incubators are frequently used to treat very low birthweight infants. Health professionals should be aware that mist and water condensation inside an incubator may significantly reduce the efficacy of treatment.

Medication errors in a neonatal intensive care unit.

OBJECTIVE: To determine the incidence and type of medical errors in a newborn intensive care unit and the relationship between the error and the patient's clinical status. METHODS: We reviewed the medical charts, during the first 7 days of hospitalization, of all high-risk newborn infants admitted for a period of 3 months. RESULTS: Seventy-three patients were admitted during the study period. Their mean birth weight was 2,140 g (640-5,020 g) and mean gestational age was 34 weeks (25-40 weeks). Of 73 medical charts analyzed, 40 (55%) had one or more errors. A total of 365 days of hospitalization was analyzed and 95 medical errors were detected (one error per 3.9 days of hospitalization). The most frequent error was associated with medication use (84.2%). Use of therapeutic procedures (drugs, phototherapy, etc.) without proper prescription in the patient's chart (commission error) accounted for 7.4% of the errors, and incidence of omission errors was 8.4%. Incidence of medical errors was significantly higher in newborn infants with lower gestational age. CONCLUSIONS: Incidence of errors in the care of high-risk newborn infants is elevated. Strategies to improve education of health professionals involved in the care and development of local culture by disseminating clear, accessible algorithms to guide behavior when errors occur must be encouraged.